This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

Institutional review board statement: Informed consent for the use of resected tissue was obtained from all patients and the study protocol was approved by the Ethics Committee of Nara Medical University.

Conflict-of-interest statement: The authors declare that they have no conflicts of interest.

Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

Core tip: There is an urgent clinical need to prediction of sorafenib response and prognosis in patients with hepatocellular carcinoma (HCC) receiving sorafenib treatment due to the potentially serious side effects of sorafenib in these patients. Multivariate analysis showed that the von Willebrand factor (VWF) antigen (VWF:Ag)/a disintegrin-like and metalloproteinase with thrombospondin type-1 motifs 13 (ADAMTS13) activity (ADAMTS13:AC) ratio was the only predictive factor for sorafenib response and ADAMTS13:AC was the only prognostic factor in patients with HCC receiving sorafenib treatment. The VWF:Ag/ADAMTS13:AC ratio and ADAMTS13:AC are potentially useful biomarkers for sorafenib response and prognosis, respectively, in patients with HCC receiving sorafenib treatment.